Some Eating Disorder Web Sites Discourage Recovery: Study

Glorification of this often-fatal disorder is flourishing, researchers find

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"Pro-ana" forums like these are sprouting throughout the Web, and a new study finds that teens with an eating disorder who visit these sites fare far worse than other young anorexics or bulimics.

According to researchers at Stanford University and Lucile Packard Children's Hospital (LPCH) in Palo Alto, Calif., 40 percent of patients interviewed had visited such sites. Teens with an eating disorder who frequent these sites were hospitalized three times more than nonusers, the researchers said.

And the study, presented at this week's meeting of the Pediatric Academic Societies in Washington, D.C., found that nearly two-thirds (61 percent) of visitors to pro-eating-disorder sites used new weight loss or purging techniques they learned about through the sites.

These online forums "seem to give teens an outlet to express their private eating-disorder thoughts in an anonymous forum," said study co-author Dr. Rebecka Peebles, adolescent medicine specialist at LPCH. With provocative words and images, the sites' warnings about entering give them a "forbidden fruit" ambience that can actually appeal to teens, Peebles said.

Pro-eating-disorder Web sites have proliferated on the Internet, luring vulnerable teens into viewing anorexia or bulimia as a "lifestyle choice" rather than an illness. In fact, these sites now outnumber pro-recovery sites five to one, experts point out. By 2003 -- the last time experts attempted a precise count -- over 500 "pro-ana" sites existed on the Internet, Peebles said.

Besides offering confused young girls "support" in staying away from food, the Web sites provide girls and women with new methods of hiding their eating disorder behaviors, cheating on weigh-ins at the doctor's office, and providing what the sites call "thinspiration" -- glamour shots of thin women and celebrities, and specially designed goal-weight charts.

Some sites even include a special food pyramid, with food placed at the narrow tip to be used sparingly while the bulk of the structure promotes large rations of water, diet soda, black coffee and cigarettes.

Many also sell merchandise such as "Mia" (code for Bulimia) and "Ana" (code for anorexia) jewelry, t-shirts and other products. These products help fund the Web sites.

"Especially for teens in recovery, they have so many people pushing against their eating disorder, such as doctors and parents, that these sites support that part of their brain that says 'yes' to the eating disorder," said Dr. Martin Fisher, chief of the division of adolescent medicine at Schneider Children's Hospital in Manhasset, N.Y.

The fear is that for those with an undiagnosed and untreated eating disorder, this sense of community with other victims could spur the disease on, encouraging destructive weight loss behavior and thoughts. "It's also one way of slowing recovery for those receiving treatment," Fisher said.

Another concern among experts hoping to curb anorexia and bulimia is that these Web sites might trigger new cases in vulnerable -- but as-yet unaffected -- teens, said Peebles.

Signs that teens are visiting pro-eating-disorder sites may include rapidly losing weight, being familiar with terms like Mia and Ana, wearing solidarity jewelry -- most commonly represented by thin strands of red or blue beads -- and/or spending lots of time on the Web.

Parents can't monitor all teen Web activity, of course. And study co-author Jenny Wilson, a Stanford medical student, said the tricky thing is that many pro-eating-disorder Web site users also frequent pro-recovery sites. Even these sites sometimes exacerbate risky behavior, since they allow visitors to confide in one another on topics such as weight-loss strategies.

Dialogue between an affected teen and her parents is key, the researchers said. Concerned parents can direct their child to sites with constructive support in beating anorexia or bulimia, Peebles said. She believes some of the best sites include www.somethingfishy.org or www.renfrew.org.

Wilson said that, right now, "there's a need to fill that technological gap" when it comes to constructive Web sites that "meet the demands of surfing teens." "Cool" sites with good information are in short order, she said, but they could be helpful in enticing teens to learn about more healthy behaviors.

"It's difficult to treat eating disorders, with or without the Web sites," said Fisher. "They just add one more variable, and it's quite dismaying."